Defining Bad News

Defining Bad News

Bad news is “any news that adversely and seriously affects an individual’s view of his or her future” (Buckman 1984).

All bad news, therefore, has serious adverse consequences for patients and families (Fallowfield 1998Ptacek 1996).

It is important to define the central element of bad news-that is, to try to identify what makes it so bad for the patient. In most cases this is fairly obvious e.g. diagnosis of a serious life limiting illness and consequently dealing with a limited life span and/or loss of function and/or quality of life.

The impact of bad news is proportional to its effect in changing the patient’s expectations.

Other Definitions

  • “Bad news is information that has an adverse and serious effect on an individual’s view of his or her future, noting that bad news is always a subjective appraisal by the individual receiving the news” (Baile et al. Oncologist, 2000).
  • Bad news is “any information that produces a negative alteration to a person’s expectations about their present and future” (Fallowfield, Lancet, 2004).
  • “Bad news is difficult to define because participants in a medical interaction appraise information subjectively as good, neutral, or bad, and therefore, almost any news has the potential to be bad. News is bad to the extent that it results in a cognitive, behavioral, or emotional deficit in the person receiving the news that persists for some time after the news is received” (Ptacek, JAMA, 1996).

Delivering Bad News

Breaking bad news about a serious life limiting illness or a chronic life altering illness and supporting patients as they progress through the illness process is arguably one the most stressful activities any clinician must perform. However, most clinicians do not receive any formal training on how to break bad news and skillfully conduct crucial conversations with patients and families.

Examples of Illnesses

Category

Examples

Life-limiting serious illnesses
  • cancer,
  • hematological malignancies,
  • advanced heart disease of any etiology,
  • advanced lung disease of any etiology,
  • advanced neurological disease of any etiology,
  • advanced renal disease of any etiology,
  • advanced liver disease of any etiology and
  • Acquired Immuno Deficiency Syndrome
Life-altering chronic illnesses
  • diabetes,
  • hypertension,
  • rheumatologic illnesses (rheumatoid arthritis, lupus, fibromyalgia),
  • chronic heart failure,
  • coronary heart disease,
  • cirrhosis, chronic renal failure,
  • chronic lung diseases (chronic obstructive pulmonary disease, cystic fibrosis)
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